• Brian M Snelling, Samir Sur, Sumedh S Shah, Stephanie Chen, Simon A Menaker, David J McCarthy, Dileep R Yavagal, Eric C Peterson, and Robert M Starke.
• Marcus Neuroscience Institute, Boca Raton Regional Hospital, Boca Raton, Florida, USA; Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.
• World Neurosurg. 2018 Dec 1; 120: e976-e983.

BackgroundReperfusion time influences patient outcome in mechanical thrombectomy for large vessel occlusion. We analyzed anatomic features that could be used to make preoperative and intraoperative decisions to minimize revascularization time.MethodsWe reviewed a prospectively maintained database for patients with stroke evaluated from February 2015 to July 2016. Patients received a score based on bovine arch, aortic arch, and internal carotid artery dolichoarteriopathy (B.A.D. score), which we correlated with procedural times and outcomes. Univariate analysis was performed to identify predictors of procedural times, revascularization, complications, and outcome. Relevant variables were assessed via multivariate regression.ResultsWe identified 61 patients (31 men) who underwent transfemoral thrombectomy. Mean puncture to reperfusion time was 46 minutes. Age >75 years (odds ratio [OR] = 3.98; 95% confidence interval [CI], 1.17-13.54; P = 0.027) and high B.A.D. score (OR = 2.55; 95% CI, 1.17-5.57; P = 0.019) were significant predictors of puncture to reperfusion time >40 minutes. Mean puncture to first-pass time was 24 ± 14.2 minutes. Age >65 years (OR = 4.68; 95% CI, 1.07-20.55; P = 0.041) and high B.A.D. score (OR = 2.84; 95% CI, 1.18-6.85; P = 0.020) were independently predictive of time to first pass >20 minutes. Lower scores predicted higher Thrombolysis In Cerebral Infarction score (OR = 0.07; 95% CI, 0.01-0.81; P = 0.033). Higher scores predicted hemorrhagic transformation (OR = 4.8; 95% CI, 1.19-12.29; P = 0.024) and modified Rankin Scale score >4 (OR = 3.0; 95% CI, 1.15-7.92; P = 0.025) after thrombectomy.ConclusionsBovine variation, aortic arch type, and internal carotid artery dolichoarteriopathy are associated with increased revascularization time and poor outcomes in thrombectomy. We developed the B.A.D. score to predict reperfusion time and outcomes, demonstrating need for preoperative anatomic evaluation to guide treatment.Copyright © 2018 Elsevier Inc. All rights reserved.

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